Catabolic State and Adrenal Fatigue Syndrome – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH

Catabolic state makes you lose muscleCatabolism is the general term for a combination of metabolic activities that break down large molecules, such as lipids and proteins into much smaller molecules like nucleotides, amino acids, and fatty acids. By doing so, catabolism provides energy for all cells to maintain their function and grow starting from the time food is ingested. Anabolism is exactly the opposite. Together, catabolism and anabolism are integral and opposite parts of the metabolic cycle that require perfect balance to maintain a strong body, healthy weight, and stable muscle mass. If these activities are not in balance, the body can be in a catabolic state.

Adrenal Fatigue Syndrome (AFS) is a neuroendocrine condition induced by stress and characterized by fatigue. There are four stages, with symptoms ranging from mild to severe. In the advanced stages, one can be incapacitated and unable to work or lead a normal social life due to lack of energy. Symptoms of advanced AFS include reactive hypoglycemia, heart palpitations, lightheadedness or dizziness on arising, insomnia, fatigue, salt cravings, brain fog, low blood pressure, loss of muscle mass, GI disturbances, belatedness, and weight loss. These symptoms are very similar to those suffering from advanced catabolic state. Indeed most sufferers of AFS in advanced stages are in a clinical or sub-clinical catabolic state with many negative consequences.

Let us first take a step back and examine the physiology of catabolism.

Metabolic Cycle

The human metabolic cycle has two different components, anabolism, which is named after the Greek word for building up, and catabolism, which means breaking down. The processes involved in anabolism consist of the synthesizing of proteins, which is the building of complex physiological structures, such as muscle tissue, from more basic structures like amino acids. Hormones, such as testosterone, human growth and insulin, usually stimulate the process. When your body is in an anabolic state it is rebuilding and repairing your bodily tissues by reconstructing their structure cell by cell. This consumes energy, and the energy comes from the process of catabolism.

By breaking down food to generate energy, catabolism assists the body in providing fuel needed to function on a day to day basis. Extra energy is used for anabolism. Catabolism is therefore part of normal daily living. Some of the known catabolic processes include:

  • Breakdown of adipose fat stores to form fatty acids
  • Cycle of citric acid
  • Process of glycolosis
  • Breakdown of muscle protein for gluconeogenesis

Catabolism followed by anabolism completes the metabolic cycle. Growing children have a heavy bias towards anabolism until they reach adulthood. Throughout our young and mid-adult years, the cycle is balanced with catabolism offsetting anabolism and vice versa. Food ingested turns to energy for daily living and cellular repair. Our metabolic cycle is balanced, and our body is in optimum health. With intake of energy equally distributed, our adult weight usually remains steady and muscle mass is maintained. Sedentary lifestyles and the catabolic stateWith excessive food intake, sedentary lifestyle, severe stress, chronic illness, etc., the metabolic cycle can be thrown off balance. Also, as we get older, the metabolic cycle bias starts to shift slightly towards catabolism as we lose about 14 percent of our muscle mass for every decade in our adult life. To maintain muscle mass and tone, the elderly need to incorporate weight training into their daily exercise program to avoid the loss of protein and muscle mass that is part of the normal aging process.

In times of emergency, catabolism can be a life saver in providing much needed quick energy. For example, when you are in the midst of an intense workout, your body is breaking down complex sugars and converting them into glucose, and the glucose is then converted into adenosine triphosphate (ATP). This is the basic energy needed for fueling the workout.

Typically we get 60 percent of our calories from consuming carbohydrates, we get 30 percent from consuming fat, and just 5 percent to 10 percent from the proteins we eat. The balance of the protein we consume is utilized by our body for protein synthesis in an anabolic process that replenishes what is lost.

Excessive Catabolism

Excessive or prolonged catabolism without adequate compensating anabolism, however, has negative consequences. Muscle tissue along with essential fat deposits throughout the body can become depleted. Without sufficient anabolic replenishment, the process of growing and repairing tissue cannot take place fast enough. The body enters a net negative energy state. The key clinical sign of catabolic state is gradual weight loss with reduction of muscle mass and subcutaneous fat. Overall weight may not be substantially reduced in early stages. Fatigue is often associated as less energy means a reduction in vitality.

If not reversed in timely fashion, chronic catabolism results. This is called the catabolic state. The metabolic cycle is now firmly entrenched in favor of catabolism. The body is in a state of low energy. Fatigue, exercise intolerance, and inability to handle stress are typical symptoms.

AFS sufferers in advanced stages are often in a clinical or subclinical catabolic state. There may not be any obvious signs of weight loss if it is subclinical. In fact, one can be gaining weight part of the time in a catabolic state as the body is cannibalizing muscle for energy when muscle is available. Needless to say, this cannot be ongoing as there is only limited muscle to be sacrificed for energy before internal organs are affected negatively. Weight is an important indicator but not the only parameter of catabolism in the early stages.

A man rundown from the Catabolic StateObviously, a catabolic state is undesirable. If not reversed, the body enters a more severe state called catabolic wasting or cachexia, where central fat persists but peripheral fat and muscle mass diminishes rapidly, resulting in persistent weight loss or an inability to gain weight. Catabolic wasting or cachexia is characterized by at least a 5 percent loss of the patient’s overall, normal body weight. Most of the time, it is up to a 20 percent loss.

Causes of Catabolic State

There are usually a variety of factors that contribute and cause catabolic wasting. A state of subclinical malnutrition exists that is not caused by insufficient food but rather inadequate absorption of nutrient assimilation across the gut from where it really counts at the cellular level. This often happens in the late stages of a chronic illness or cancer, both causes a marked loss of fat stores and muscle tissue. Although a reduced appetite usually accompanies cachexia, an increase in the intake of food alone hardly ever helps.

Common causes include:

  • Aggressive detoxification when the body is not ready
  • Major surgery leading to muscle trauma and loss of collagen
  • Major accident leading to systemic inflammation and muscle breakdown
  • Chronic infection, such as Lyme disease or H. Pylori
  • Cancer in advanced stages as cancer cells overtake normal cells and their metabolic activities, draining the body of nutritional reserves.
  • Chronic liver disease leading to slow down in metabolic processing and increased internal toxic load which in turn breaks down protein
  • Antibiotic use in a body not prepared
  • Chronic stress (one of the most frequently overlooked triggers of subclinical catabolism)
  • Dehydration
  • Excessive exercise uses the body’s store of glycogen and glucose. When this happens, it can start to breakdown muscle and connective tissue for energy.
  • Prolonged fasting forces the body to catabolize muscle for energy
  • Advanced Adrenal Fatigue Syndrome, where the body enters a catabolic state as a compensatory mechanism to generate energy from internal sources.

Inflammation is the common pathway of catabolism and muscle mass deterioration. Chronic and acute illnesses can result in major increases in inflammatory cell-signaling molecules known as cytokines. Major surgeries, severe accidents and infections are some frequent contributors. They trigger massive inflammatory responses, which result in reduced synthesis of muscle protein and raise its breakdown rate. Cytokines also trigger the release of neurotransmitters called catecholamines and the adrenal hormone cortisol, creating a vicious positive cycle of catabolism. Both of these can increase catabolic wasting because they disrupt the metabolism of muscle cells and change the basal metabolic rate.

Catabolic State

A catabolic state, depending on whether it is clinical or subclinical, is characterized biochemically by an imbalance in catabolic hormones such as cortisol in various degrees as catabolism progresses.

A catabolic state will tire you outCatabolic hormones help generate energy for the body’s needs by way of producing ATP. ATP allows your cells to use the energy that is released in the process of catabolism to fuel its immediate cellular needs for proper function. So, even when your body is in a state of catabolism, it is attempting to take care of what would be best in terms of your overall health. Along with catabolism is increased oxidative damage, high levels of systemic inflammation and lower levels of anabolic hormones such as testosterone and growth hormone. Cortisol may be high at the start of catabolism, but ultimately becomes low, as the body is unable to put out more when the catabolic state becomes severe.

Symptoms of Catabolic State

This may not seem like much of a problem on the surface, but imagine the damage that could be done if you remained in a continuous state of depletion for a long time. When the healthy muscle tissue is enduring long stretches of time in a catabolic state, the tissue ends up eating away at itself. This is due to it seeking a stored-up source of energy. Muscle mass begins to reduce, metabolites of muscle breakdown can congest the liver and damage the kidneys, just to mention a few negative consequences. As the weight goes further down, the immune system becomes affected, brain fog surges, balance can be problematic, and respiratory function compromised due to reduced muscular tone to expand the chest cage. Fatigue increases with shortness of breath and reduced oxygen intake. In their last days, most advanced cancer sufferers are in a catabolic state suffering from cachexia.

Symptoms alert for catabolic state:

  • Lack of exercise tolerance
  • Low baseline energy state
  • Fatigue easily on exertion
  • Failure to gain weight despite excessive caloric intake
  • Unexplained weight loss that is not part of a weight management program
  • Symptoms of gastrointestinal tract slow down, such as bloating, constipation, food sensitivities, and allergies
  • Inability to tolerate or increased sensitivities to certain kinds of food, such as tomatoes, almonds, diary, gluten, and wheat
  • Lack of energy on one seating to complete a regular meal, requiring one to two hours to complete a meal
  • Brain fog as toxic metabolites build up
  • Insomnia
  • Liver area discomfort or pain
  • Muscle cramps
  • Shortness of breath and inability to take deep respiration
  • Weak urinary stream
  • Visible loss of muscle mass, especially at the biceps, triceps, chest, and gluteus muscles
  • Increased skin pigmentation and age spots
  • Increased wrinkles around the eyes and forehead
  • Low body temperature and sensitivity to cold
  • Dizziness or lightheadedness especially on arising
  • Low blood pressure
  • Hypoglycemia
  • Inability to tolerate raw foods
  • Onset of weight loss after antibiotics
  • Reduced gastric acid secretion
  • Gastric shutdown increases so that only a few bite size portions of food are tolerated at a time
  • Electrolyte imbalance, especially potassium and sodium
  • Low libido and low semen volume

Muscle cramping and soreness and a catabolic stateIt is important to note that the body can be in a state of catabolism for a long time, in what is called a subclinical state without obvious clinical symptoms until it is well entrenched. Normal daily living is unaffected. Signs and symptoms are subtle at best. These may include a gradual reduction of exercise capacity, reduced hand grip strength, greying of hair, onset of wrinkles especially around the eyes, less toned tricep muscles, persistent central fat around the abdomen that refuses to go away with exercise or diet, an increase in flu frequency as well as other infections, and GI bloat and indigestion.

Unless one is on the alert, most sufferers do not notice the gradual internal breakdown characterized by subclinical catabolism until it is too late. This is because the body has a compensatory mechanism, which is activated automatically. Unfortunately, an unresolved subclinical state of catabolism will advance towards a state of catabolic wasting if it is not reversed but allowed to continue unabated. The key to detecting subclinical catabolism is to see the overall big picture clinically from afar—one of a body slowing down, loosing vitality and muscle, trying to hang on to what it has nutritionally. The body has various degrees of slow down modes as it tries to conserve energy, with resulting loss of vibrancy and vitality.

It comes as no surprise that the catabolic state, either clinical or subclinical, is strongly associated with those suffering from cancer, chronic infection, and severe stress. Other conditions, such as irritable bowel disease, heart, liver and lung disease, rheumatoid arthritis and various conditions presenting with fatigue as their primary symptom including chronic fatigue syndrome and Adrenal Fatigue Syndrome are also frequently associated with a catabolic state. Once entered, the catabolic state is self-propelling in a downward vicious physiological cycle that is detrimental to quality of life and in most cases causes the underlying medical condition to worsen.

Read Part 2 | Part 3 | Part 4

© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

A catabolic state is when your body’s breakdown process exceed that of built up. Weight loss and fatigue ensue.

Research has shown the use of cryotherapy can reduce inflammation.

A man rundown from the Catabolic State
5 - "Thanks, Dr. Lam!"
Thanks, Dr. Lam! You have done a fabulous job educationg people like myself through your website!


  • Tracy says:

    Do steroids halt catabolism?

  • Todd says:

    Can anti-depressants affect the catabolic state, or am I just feeling the sedative effects?

    • Dr.Lam says:

      Anti-depressants can lead to appetite suppression. A catabolic state is the end result of a body in trouble with metabolic issues.

      Dr. Lam

  • Emanuel says:

    I have a daughter that cannot gain muscle/ weight no matter what she eats. She has been thin her whole life, but Im concerned that she might be borderline catabolic. How do I know for sure?

  • Concerned says:

    Is it possible to reverse the damage caused from catabolism?

    • Dr.Lam says:

      The body has the ability to self-heal if the damage is not too severe and the body has the right tools to do it.


  • Betsy says:

    How would I tell the difference between catabolism symptoms (wrinkles around eyes, reduced grip strengthm graying hair, etc) and just plain old getting old?

    • Dr.Lam says:

      The big picture is very different. As you get older, there is a certain level of catabolism. When you are in a catabolic state, you are usually quite weak.


  • Melanie says:

    In the year 2000 when I was 26 years old I noticed I suddenly became very thin after a stressful event at home. In 2002 I was still the same and approached my doctor who couldn’t find anything wrong with me. In desperation I visited a nutritionist and after she did a hair mineral analyst test and saliva test it was discovered I had Adrenal Insufficiency. After several visits to different conventional doctors over the years they have still found nothing wrong with me and say my thyroid levels are normal. I am now nearly 43 and I am even thinner to the point where my whole body is very bony and there is hardly anything left on my arms. I have many of the symptoms of Adrenal problems and Catabolism. I still have menstruation but my cycles are quite short these days. My iron levels are low. My doctor prescribed me with a course of vitamin D because they found my levels of Vitamin D were very low. My body mass seems to drop off every time I encounter emotional traumas or stressful events. This last two years saw a death in the family, followed by my parents both having serious health problems and since all this happened my body is wasting away. I’m scared of what is happening to my body and I feel like I can’t control what is happening.

    • Dr.Lam says:

      Your body may be decompensating based on what you described. You need to reverse this course. The following article may help. If you need a personalized program, call my office. Click Adrenal Exhaustion for more information.


  • Randy says:

    How can you tell the difference between muscle mass lost due to catabolic state and cancer symptoms?

  • Rob says:

    What are the best food to consume when in a catabolic state?

    • Dr.Lam says:

      Food needs to be nourishing and able to be assimilated through the gut. The exact program varies from person to person as what is right for one person can be wrong for another.

      Dr Lam

  • Morgan says:

    This is amazing because I feel as though I have all of these symptoms and my Doctor and Dietician don’t have any clue what is going on! How do I get out of this Catabolic cycle?

    • Dr.Lam says:

      It is hard to self navigate which can worsen you. Seeking professional help is key as this can be quite serious.

      Dr Lam

  • Stuart says:

    Hi Dr Lam. I have chronic fatigue syndrome and housebound. I recently took amitryptyline for six weeks and had a bad reaction to it only I have continued to slowly get worse over the next three months to the point of being completely bed ridden and all vitality has drained away, now my appetite has completely gone and losing weight with severe depression and my gut feels dead and I seen your comment on restarting the gut and was just wondering where could you advise me to go to find out about healing the gut. Thanks Stuart.

  • Kristopher Keyes says:

    According to this article, I without a doubt am in a catabolic state. I am a college student 23 years old. For several years, despite regularly eating massive amounts of food and not exercising much, I have not gained any weight. In fact, in the past two months (i.e. since mid-October, the time I first noticed serious symptoms of AFS) I have actually lost about 20 lbs. Right now, I am 6′ 6″ and only 190 lbs. Doctors tell me to eat more, and I am trying to do that. When I first noticed pain in my chest, I thought I was on the verge of a heart attack. But two EKGs and multiple blood pressure and glucose tests tell me my heart is fine. Now I can actually feel my muscles deteriorating, especially my pectorals. Blood tests reveal nothing serious, although for a little while I had low potassium. What should I do? I have one more semester before graduation, and it will be a difficult one. I hardly made it through this semester due to the fatigue. What can I, as a young man, do to conserve as much energy I can for the next few months? What can I do this next month I am off school to recover?

    • Dr.Lam says:

      Catabolic state can be very serious and professional care is advised. Simply forcing calorie into the body when it is resisting, as in a setting of AFS, can do more harm than good. The key is to seek someone who really knows.

      Dr Lam

  • Ingrid says:

    I’ve heard that being in a catabolic state is good for weight loss when working out in fact they even praise the catabolic diet, yet you’re explaining that being in a catabolic state is a bad thing for the body. does that mean that having a catabolic diet to induce catabolism is hurting my body while trying to loose weight?

    • Dr.Lam says:

      Catabolic state associated with AFS is often chronic and the body is very weak. It is very different from a healthy body going through a temporary induced catabolic state for weight loss, which is also not recommended.

      Dr Lam

  • Stephan says:

    Can catabolism damage the kidneys?

  • Mark says:

    What is the best way to get out of a catabolic state?

    • Dr.Lam says:

      You have to get the body to restart the gut, and supporting the adrenals is an important step towards that.

      Dr Lam

  • Amelia says:

    Are there clear guidelines for how much catabolism is expected at certain ages, or with specific conditions? I feel quite weak at times and don’t want to miss something important.

    • Dr.Lam says:

      Normal people have no catabolism throughout their life time. Extreme old age, cancer , severe trauma are come external causes of catabolism. Weakness is not the same as catabolism.

      Dr Lam

  • Leah says:

    I’m 49 and have gone through and (barely) survived this phase of Adrenal failure/burnout, on my own, without drugs, using herbal and vitamin/mineral supplements, TONS of sleep, good diet and self education – from 2013, peaking in 2014, and still on my way back up to normal… how long does it take to resume my busy schedule (I’m a busy Architect with my own business in the Silicon Valley, CA) and exercise programs (Power Yoga, Crossfit, Running) without feeling “depleted” or overexerted/exhausted? I still have fallout, too, from people thinking I’m scattered, flaky, paranoid, etc… do you have any suggestions as to how to explain to colleagues, clients and friends about what I’ve gone through that will help me remain in good standing professionally?
    Thank you,

    • Dr.Lam says:

      A general ballpark could range from 6 months to a few years. I know this is a big range and it is impossible to be more narrowed because of individual variance. It is very common to have relapses and that is what happen to many who feel better and then worse. Consistent recovery over time is challenging and requires a very detailed plan when you are in catabolic state. It is hard to explain to people. Give them my book which has a whole chapter on this may be helpful. Click Book – Advanced Symptoms Adrenal Fatigue Syndrome – A Metabolic Perspective for more information.

      Dr Lam

  • Jay THomas says:

    In a nutshell…..
    I’m quite at a loss as to what’s happening to me. I’m 44 years old, and an avid competitive inline speed skater but also work full time and work a little bit as a musician. About a year and a half ago, I took a saliva test through my naturopath. It indicated stage three Adrenal Fatigue along with several neurotransmitters that were in the low range. I was given a protocol and some of the symptoms cleared up- no longer light-headed/dizzy when I got up, didnt feel completely drained after a heavy work out. Fast-word to last December. I hit a skid of insomnia that really hasn’t let up along with reduced muscle mass and athletic performance. Skating no longer was fun. This coincided with a sharp increase in job demand and stress that has only gotten worse. I also came off of antidepressants a year ago too. I have lost about 25 pounds in the last year and i’m not trying too which leads me to believe that I’m in a catabolic state. I can go out and train hard sometime,s but I usually pay dearly for it. I don’t sleep well at night, and find it hard to motivate and get through a day of work. I have not clue what to do.

    • Dr.Lam says:

      Excessive exercise, stress etc can bought on the body generating energy needed from your internal sources like muscle. You should see your doctor to make sure no other reasons for this happening, and if all work up is normal, you need to focus your attention on AFS. Catabolic state needs to be reversed as it is a positive vicious cycle. We handle this type of situation by telephone coaching so do not give up.

      Dr Lam

  • Heather says:

    Should I be concerned? I began working with a naturopath for relief of perimenopause symptoms this year and have been using progesterone cream. Six months ago, my AM cortisol was 1.6 ng/ml (range 1.8-3.8), my PM was 0.33 ng/ml (range 0.1-0.8). AM DHEA was 0.15 ng/ml (range 0.1 – 1.3). Two months ago, my AM cortisol dropped a bit to 1.26 ng/ml and went up in PM to 2.63 ng/ml. DHEA dropped to

    Over the past few months, I have lost 10% of my body weight despite being completely sedentary. I am extremely weak (not just tired), very low appetite, frequent nausea, some episodes of vomiting, frequent (near daily) headaches. Frequently feel as if I am shaking inside especially in morning and during day. I do feel a bit more energy in evening. To combat the weight loss I am trying to eat more food and protein, but its very difficult when I have such a low appetite. I do feel like I am getting worse over time rather than improving, despite much rest, B-vitamins, etc. Any suggestions appreciated! Thank you

    • Dr.Lam says:

      Catabolic state can be quite serious as once you enter, it is hard to come back without a good plan and often times people get worse by the wrong appraoch. if you are loosing weight for no reason, see your doctor first and foremost to make sure nothing else going on . You dont want to jump to conclusion it is AFS too quickly. Laboratory test are not very good as the numbers can be very misleading. Be careful. Click Laboratory Testing for more information.
      A detailed history by an AFS literate practitioner will be able to guide you. That is your best bet.

      Dr Lam.

  • Allen says:

    Are there any supplements that can directly slow down catabolism? My doctor is really trying hard to embrace AFS, but she doesn’t know where to start.

  • Angela Reeve says:

    I have hashimotos , leaky gut and adrenal fatigue and after reading this article I am certain I am in a catabolic state as I have lost weight, muscle mass and fat especially around my chest and arms, and have hyperpigmentation on my shins and the top of one arm. I eat 3 good meals a day but feel and look like I’m losing my vitality. I have I noticed that I have aged significantly around my eyes have many of the symptoms you describe in this article. . I am taking thyroid S for my thyroid and liquorice for my adrenals. How do I improve this condition and am very concerned about finding a doctor who will be able to provide me with good advice and correct treatment as most GPs dont even recognise adrenaI fatigue let alone treat it. I do not want my condition to get any worse.

    • Dr.Lam says:

      When you suspect catabolic state, self navigation will usually fail and makes matter worse because when the body is fragile, even the right thing can be wrong at times. Seek professional help is best if you are at this point is your best bet. The recovery process is long and filled with setbacks even in the best of hands.

      Dr Lam

  • Jamie says:

    So fascinating! Thank you Dr.Lam! my question is are the supplements that you would recommend to help with balancing anabolism and catabolism?

    • Dr.Lam says:

      Supplements must be very carefully titrated not to make the body worse and time properly. Everyone is different. What works for one may backfire on another because by the time catabolism sets in, one first has to stabilize the body before supplements can even be considered. There is no protocol possible .

      DR Lam

  • Givemehope says:

    I am on bedrest after an interstate move (that I had to do, to alleviate stressors….while I was in stage 3). I have crashed pretty hard, and I am in a catabolic state with dark circles, flank pain off and on, strong “barnyard” smelling urine which is so emberassing….every Western doc and lab test comes up with nothing to move on. My postural hypotension has me in bed/at rest most of the time now. And I’m just stumped. I have a peaceful home, partner support, electrolytes, I’ve increased my sodium to 1/4 tsp with water per day…..and I know the 90 essential minerals in powder form should begin to assist me as well, but they dont come until tomorrow. When I try any pills (except micronized Vit C), I get a paradoxical reaction, so I’m nervous. The minerals get here tomorrow, they’re in powder form, so I can drink them instead. My question is, “What can I do to support myself until I get in to see a Western doc that will help me with diagnostics? I am scheduled a month out, and my low blood pressure is really hard to work with. I am a traditional Chinese medicine person, always have been, until this. Now I can’t find a Western doc that is willing to delve into your book, certainly not listen to ME…..and I know I’m not alone in this. Thank you for your service. And advice. You have been a God-send to me and my family.

    • Dr.Lam says:

      Do be very careful with minerals as given a fragile state you are in with history of sensitiviey and paradoxical reaction, it can potentially makes matters worse, though you may find some short term help in the best case senerio. Finding nothing in lab test is normal. you really need to find a professional to help you in this type of situation as lab and regular alternative doc do not see enough of cases like yours in their normal practice and agressive steps to ‘reverse” what you have may backfire easily. Click 7 Adrenal Fatigue Recovery Mistakes for more information.

      Dr Lam

  • Kim says:

    Dear Dr. Lam, When I took my test the instructions on the kit said to take as soon as I got up in the morning, not start between 6 and 8 am, as I was told by Stop the Thyroid Madness I should have did. My results were: Cortisol- saliva- 2.6 ng/ml (range 3.7-9.5 morning),taken 11 am
    Cortisol- 1.8 ng/ml (range 1.2-3.0 noon), 4pm
    Cortisol 0.8 ng/ml (range 0.6-1.9 evening), taken 8pm
    Cortisol saliva- 1.4 ng/ml (range 0.4-1.0 night), taken 11 pm
    DHEA-S 1.5 range 2-23
    Since I am testing within a group of people could my results have been different with a different group of people? I was started on sex hormones, herbal and cortex supplements, and thyroid meds all at once. I had side effects from the thyroid and went off cold turkey one day, then went on 1/2 dose 2 days , then off completely one day, then on 1/4 dose 2 days. Needless to say I crashed horribly and now have dark circles under my eyes & air hunger. I then was told to treat adrenals with cortex, so I did that for one month, went off and crashed horribly. I am telling you my face actually fell both times and I look worse now than before I went on any of this! I have been taking vit c & Garden of life vitamins with extra Vit d3 and K2 as I see my leg veins are getting more prominent. It has been 6 months and I am beginning to feel better. Thyroid tests are RT3 is 18.5 (range 8-25), Free T3 – 3.0, (range 1.8-4.6) Free T4 –1.33 (range 0.9-1.7), TSH 1.650 (range 0.27-4.2), TPO ab– 8.1 (range ,35), & TG– 12.4 (range <115). I have high ferritin at 162 (range 13-300). I have ears that burn inside from a double ear infection in 2006 & costochondritis of the breastbone. My one saving Grace was that I looked younger, now I look old and tired. I will most likely need injectable fillers to replenish my cheek area. Worse, I am sick and cannot work. I read you recommend treating adrenals 3-6 months, is that with cortex? I have been told that if I need thyroid no supplementation with iodine will help and I must titer up every 2 weeks or so for thyroid NDT & cortex. I was never told that when I was on it. PLEASE HELP. I have a hard time with foreign accents and could not understand the woman I spoke with earlier & prefer you to answer if possible. You do not have to publish this.

    • Dr.Lam says:

      Your situation is complex, but here are a few general pointers. First of all , low am cortisol and high night cortisol is what is known as reverse curve and it points to internal imbalances that often is deeper than just simple adrenal fatigue that usually presents as a flat curve in advance stages. your body is quite sensitive and adrenal cortex may make it worse. Thyroid test are not very helpful in cases like yours unless they are really off. Supporting the adrenals are good , but the way it is done has to depend on the person and it varies. What is right for one can backfire for another. With your complicated history , you should best consult an AFS literate practitioner as the wrong move can make you worse.

      Dr Lam

  • Phil says:

    Great article! I myself believe i am in the subclinical state, what should be my first step to resolve this?

    • Dr.Lam says:

      You should see your doctor to make sure all is steady. Resolving the underlying stressor is the ultimate solution, and supporting the adrenals properly without further degrading it is the key. The three steps are outline in my paper, but since most people are quite weak by the time this is suspected, you need a personalized program to really do it right as the body will change.

      Dr Lam

  • Hank G. says:

    When dealing with a catabolic body, should one be eating foods/snack that take longer to process within the body, such as Fatty foods or high protein foods ?

    • Dr.Lam says:

      It really depends on each person because by the time catabolic state is suspected, the body’s internal metabolism is often dysregulated, so the ratio of protein / carb / fat varies and is persona specific.

      Dr Lam

  • Maria says:

    Dear Dr. Lam.

    I found this very informative and useful. I would like to cite this page. Do you have a date for this post?


  • Joan says:

    Can you be over weight and still feel like you are in a catabolic state ?

    • Dr.Lam says:

      Catabolic state is a process. It starts when the weight is normal or high and slowly goes down with time. In advance stages, one is underweight. In the process, one can be overweight or normal weight. Typically by the time catabolic state is suspected, one is underweight

      Dr Lam

    • Dr.Lam says:

      Resting is one way, but if you are already on hormones, resting can backfire and makes matter worse so you need to talk to your doctor before embarking any self navigation.

      Dr Lam

  • Victoria says:

    Why is detoxification dangerous when the body is in a catabolic state?

  • Victor says:

    Hello dr lam. Whats ti your opinion of to take ldn (low dose naltrexone) to catabolic state and adrenal fatigue? Thank you

    • Dr.Lam says:

      You have to be very careful of embarking on any program when in catabolic state until the body is stabilized. Often times things looks promising on paper and in theory ,but remember than by the time an AFS sufferer is in catabolic state, the body is quite weak and fragile. Even the slightest intolerance or mishaps can trigger crashes. Unfortunately I have to alert you on this because we have many on our coaching program that comes to us after trying to do their best but got worse over time. Its often times not about the modality, but about not having enough experience to know what and when to do at what intensity and frequency. The right thing done at the wrong time can make matters worse.

      Dr Lam

  • Jeanette says:

    Hello Dr Lam, I believe I have been in this subclinical state for past 2 years after having my 4th child at 43. Fatigue, hair loss, gastric intolerances, chronic tendonitis are biggest complaints. I have normal TSH (2.3) with low iron & got D levels, slightly elevated blood sugar. How does one reverse this catabolic state? I think know, it’s probably exercise! What else can one do to reverse it?

    • Jeanette says:

      …Low Vitamin D levels.

    • Dr.Lam says:

      Exercise can worsen catablolic state. If you suspect you are in catabolic state, which only affects the most advance cases, then you need to seek professional help. Recovery can be very complex and properly planned to avoid worsening as the body then to be quite fragile. Simple fatigue, hair loss is not catabolic state. Weight loss is a primary component. So I need you to make sure and if you have doubt, see your doctor.

  • Carolina says:

    I have elevated proline and very elevated glycine. I’ve had elevated amylase, lipase and slightly elevated alkaline phosphatase for the last 3 years when I started feeling unwell. Can these indicate a catabolic state? Thank you!

    • Dr.Lam says:

      You need to check with your doctor and correlated with the clinical picture. Amylase, lipase are associated with pancreatic function. Alklaline phos has to do with liver. Without a lot of history, going by lab alone is not accurate and can be misleading.

      Dr Lam